An alliance of drug companies and patient advocates, joined by Democrats and Republicans in Congress, is fiercely opposing an Obama administration proposal that would allow insurers to limit Medicare coverage for certain classes of drugs, including those used to treat depression and schizophrenia.

The administrations proposal would remove the protected status from three classes of drugs that has been in place since the programs inception in 2006: immunosuppressant drugs used in transplant patients, antidepressants and antipsychotic medicines. They include many well-known drugs, such as Wellbutrin, Paxil and Prozac to treat depression, and Abilify and Seroquel to treat schizophrenia. Three other categories  cancer, H.I.V. and anti-seizure drugs  would retain their status as protected classes and insurance companies would be required to continue covering nearly all drugs in those treatment areas. Medicare has traditionally required the broad coverage because patients with these conditions must often try several drugs before finding one that works.

In proposing the change last month, the administration said that the policy was envisioned as a temporary measure to help ease patients transition to the new Medicare drug program, and that since then, insurers had lost their leverage in negotiating with drug companies because the drug companies knew the insurers were required to cover their drug costs and were therefore less willing to offer lower prices.

This is CONDITION RED for my family as one of the antipsychotics on this list returned a member to sanity from a deeply psychotic condition in the past few months. Numerous other antipsychotics (whether cheap or expensive) had failed.

Some insurance protocols will cover the rarer drugs if more common ones are unsuccessfully tested first. But then the protocols are often wooden. Even if the patient has tested the unsuccessful drugs in the past, they have to be tested again, once on a particular policy.

4
posted on 02/24/2014 8:34:42 PM PST
by HiTech RedNeck
(Embrace the Lion of Judah and He will roar for you and teach you to roar too. See my page.)

“Oh so this is how they start the implementation of the death panels. The patient commits suicide.”

Sounds about right, sadly. My wife is a retired RN and I am a retired CPA and we can barely keep up with the medical issues and paperwork involved with Medicare in the family. I don’t know how the average family can survive the complexity. Those vulnerable to depression will have their risk of suicide increased, I expect.

The non time release Seroquel is $16 for 60 tablets of quetiapine 25mg (generic) at Walmart with the type of coupon I use (GoodRx). Very unusual for more frequent administration of the non-XR to not “work”.

20
posted on 02/24/2014 9:23:25 PM PST
by steve86
(Some things aren't really true but you wouldn't be half surprised if they were.)

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